Argyrios Tzamalis

Aristotle University of Thessaloniki

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Nikolaos Ziakas

Papageorgiou General Hospital

Ioannis Tsinopoulos

Papageorgiou General Hospital

Asimina Mataftsi

Papageorgiou General Hospital

Stavros Dimitrakos

Aristotle University of Thessaloniki

Nikolaos Chalvatzis

Aristotle University of Thessaloniki

Maria Dermenoudi

Papageorgiou General Hospital

Vito Romano

University of Brescia

Artemis Matsou

Queen Victoria Hospital

Chrysanthos D. Christou

Aristotle University of Thessaloniki

Myron Kynigopoulos

Kantonsschule Olten

Cooperative Institutions

Aristotle University of Thessaloniki

Papageorgiou General Hospital

University of Liverpool

Royal Liverpool University Hospital

University College London

AHEPA University Hospital

University of Thessaly

Moorfields Eye Hospital

National and Kapodistrian University of Athens

University of Brescia

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DMEK surgical training: An instructional guide on various wet-lab methods

Survey of Ophthalmology (2023)

Mohit Parekh Alessandro Ruzza M Rovati Argyrios Tzamalis Davide Romano

Descemet membrane endothelial keratoplasty (DMEK) is a partial-thickness corneal transplantation procedure that involves selective transplantation of Descemet membrane and endothelium. DMEK offers significant advantages over other keratoplasty techniques such as faster visual rehabilitation, better final visual acuity due to minimal optical interface effects, lower risk of allograft rejection and less long-term dependence on topical steroids. Despite all its advantages, DMEK has been found to be challenging than other corneal transplantation techniques, and its steep learning curve appears to be an obstacle to its widespread use and adoption by corneal surgeons worldwide. DMEK surgical training laboratories (wet labs) provide a window of opportunity for surgeons to learn, prepare, manipulate, and deliver these grafts in a risk-free environment. Wet labs are a significant learning tool especially for those institutions that have limited tissue availability in their local centers. We provide a step-by-step guide for preparing DMEK grafts using different techniques on human and non-human models with instructional videos. The article would eventually help the trainees and the educators understand the requirements for performing DMEK and conducting a DMEK wet lab and develop their skills and interests from a wide variety of available techniques.

Descemet membrane

Visual rehabilitation

10.1016/j.survophthal.2023.06.008

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Citations (9)

Pendular eyelid flap: a novel technique for the management of extensive congenital upper lid colobomas

Journal of American Association for Pediatric Ophthalmology and Strabismus (2016)

Nikolaos Chalvatzis Paraskevi Riga Argyrios Tzamalis Asimina Mataftsi

Cosmesis

Aponeurosis

Coloboma

10.1016/j.jaapos.2016.08.009

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Citations (0)

Training of Resident Ophthalmologists in Cataract Surgery: A Comparative Study of Two Approaches

Journal of Ophthalmology (2015)

Argyrios Tzamalis Lampros Lamprogiannis Nikolaos Chalvatzis Chrysanthos Symeonidis Stavros Dimitrakos

Purpose. To evaluate and compare the efficacy of two different training methods in resident-performed phacoemulsification surgery. Methods. 502 eyes of 467 patients who underwent resident-performed phacoemulsification were included in the study by reviewing their medical records. Residents were allocated into two groups according to the method applied during their training in cataract surgery; Group A included residents that were trained with the "step-by-step" method and Group B those trained with the "one-step" method. Primary outcome was the incidence of main complications, defined as posterior capsular ruptures and/or zonular dehiscence with vitreous loss. Results. Each resident performed a median of 63 phacoemulsification surgeries. A statistically significant difference (p = 0.0032) was noted in the main complications rate between the two groups, yielding a mean of 17.3% in Group A and 7.25% in Group B. Other intraoperative complications were not shown to differ statistically significantly between study groups (p > 0.05). Among the first 40 surgeries of each resident, main complications rate differed also statistically significantly (p = 0.0048) between Group A (21.67%) and Group B (8.5%), while a better surgical performance-yielding statistical significance in Group A (p = 0.017) was indicated in both groups between the 20th and the 30th procedure. Conclusions. Training in cataract surgery using the "one-step" method may lead to an improvement in surgical competency, when measured by complications rates and, therefore, to significantly better quality of training for resident ophthalmologists.

Group B

10.1155/2015/932043

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Citations (19)

Comparing hospital compensation to actual costs based on the Greek Diagnosis-Related Group system in ophthalmology

International Journal of Evidence-Based Healthcare (2018)

Argyrios Tzamalis George Chionos Periklis Brazitikos Ioannis Tsinopoulos Stavros Dimitrakos

The purpose of this study is to evaluate the effects of the new system of pricing medical services in the field of ophthalmology in Greece. In addition, it attempts to benchmark the system with respective interventions at an international level.The study deals with the implementation of the new system, presenting systematic pairing of ophthalmic coding with other coded information regarding registration and management. Statistical data analysis is performed related to the cost and, finally, proposals are formulated to improve the current system.A significant difference is noted in the quantitative and qualitative characteristics of the Greek system compared with internationally applied Diagnosis-Related Group (DRG) systems in the field of ophthalmology. The proposed funding for ophthalmic inpatient cases mostly meets real needs and costs of hospitals for supplies. Complicated cases, mainly in cataract surgery, increase the real cost and may cause a deviation depending on the rate of complications. In these cases, the average cost was 673.28 ± 58.7&OV0556; as opposed to uncomplicated cases (346.78 ± 21.3&OV0556;), bearing a statistically significant difference (P < 0.001, Mann-Whitney test). The total compensation of the hospital was higher than the actual cost for surgical procedures covering the respective expenses.Although the recently implemented compensation system for public hospitals mostly covers the actual cost for ophthalmic surgical cases, some deviations from the real needs are being identified. Several amendments could be applied to increase efficiency and improve the quality of health services provided by Greek hospitals.

10.1097/xeb.0000000000000148

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Generic trypan blue as possible cause of a cluster of toxic anterior segment syndrome cases after uneventful cataract surgery

Journal of Cataract & Refractive Surgery (2017)

Artemis Matsou Argyrios Tzamalis Nikolaos Chalvatzis Asimina Mataftsi Ioannis Tsinopoulos

Five of 16 patients having uneventful cataract surgery over 2 consecutive days presented on the first postoperative day with painless, unexpected blurry vision; marked limbus-to-limbus corneal edema; and severe anterior chamber inflammation with hypopyon and fibrin formation. Review of the records showed the 5 patients had received an intracameral injection of generic trypan blue solution 0.06% to facilitate the capsulorhexis. Patients who had not received the trypan blue injection had an uneventful first-day check and subsequent course. Management comprised intense topical steroids and close follow-up, which led to gradual improvement in all cases. The batch of trypan blue vials was withdrawn, and there were no additional cases of toxic anterior segment syndrome (TASS). This TASS cluster highlights a rarely reported cause of the syndrome, underscoring the need for thorough documentation of solutions and/or medications used intraoperatively and surgeon awareness of possible adverse events.

Trypan blue

Capsulorhexis

Hypopyon

10.1016/j.jcrs.2017.06.002

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Citations (26)

Comparison of slit lamp-adapted optical coherence tomography features of fellow eyes of acute primary angle closure and eyes with open angle glaucoma

Japanese Journal of Ophthalmology (2014)

Argyrios Tzamalis Duy-Thoai Pham Christopher Wirbelauer

Angle-closure glaucoma

10.1007/s10384-013-0301-5

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Citations (3)

The process of estimating the cost of surgery: Providing a practical framework for surgeons

The International Journal of Health Planning and Management (2022)

Chrysanthos D. Christou Eleni C. Athanasiadou Andreas Tooulias Argyrios Tzamalis Georgios Tsoulfas

Abstract Over the last decades, health care costs have been increasing at an alarming, exponential rate which is considered unsustainable. Surgical care utilizes one‐third of health care costs. Estimating, evaluating, and understanding the cost of surgery is a vital step towards cost management and reduction. Current cost estimation studies and cost‐effectiveness studies have vast disparities in their methodology, with published costs of Operating Room varying from as low as $7 and as high as $113 per minute. Costs in surgery are distinguished as direct and indirect. Allocation of direct costs involves identification, measurement, and valuation processes. Allocation of indirect costs involves the allocation of capital and overhead costs and of indirect department costs. Annualised capital costs and overhead hospital costs are then allocated to surgery by either the cost‐centre allocation or the activity‐based allocation frameworks. Indirect department costs are allocated to a specific surgery by weighted service allocation or hourly rate allocation or inpatient day allocation, or marginal markup allocation. The growing societal, financial and political pressure for cost reduction has brought cost analysis to the forefront of healthcare discussions. Thus, we believe that almost every single surgeon will eventually enter the field of healthcare economics by necessity. This review aims to provide surgeons with a practical framework for engaging in cost estimation studies.

Cost allocation

Capital cost

10.1002/hpm.3431

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Citations (11)

Reoperations After Cataract Surgery: Is the Incidence Predictable Through a Risk Factor Stratification System?

Cureus (2020)

Eirini Oustoglou Argyrios Tzamalis Ioannis Mamais Maria Dermenoudi Konstantinos T. Tsaousis

Introduction The objective of the study was to quantify the number of procedures needed to achieve the best possible surgical outcome, depending on the number and type of risk factors identified. Methods Two independent observers reviewed the medical records of 1,502 patients who underwent phacoemulsification surgery, during a two-year period (January 1, 2014 to December 31, 2015). Preoperative risk factors were documented according to the stratification system used. Based on the total risk score, each case was allocated to one of four risk groups with 0, 1-2, 3-5, and >6 total risk factors, respectively. All qualitative and quantitative characteristics were gathered and included in a multivariate analysis. Results A total of 1,792 eyes were included. Αge over 88 years, low cooperation ability with the patient, and surgeries performed by residents tended to have more often complications, while white/intumescent cataract, iridodonesis/phacodonesis, α1 blockers intake, and male gender are risk factors positively associated with more than one surgery. Conclusions Risk factors tend to be prognostic for possible intraoperative complications. The number of procedures needed for the best possible surgical outcome seems to depend on these preoperative risk factors. A stratification method increases the level of awareness of the surgeon, and therefore may decrease the number of complications and even procedures while enhancing the "safe" practice and skills of residents.

Risk Stratification

Medical record

10.7759/cureus.10693

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Citations (2)

What is the Real Cost of Intraoperative Floppy Iris Syndrome in Cataract Surgery?

Journal of Ophthalmic and Vision Research (2023)

Argyrios Tzamalis Chrysanthos D. Christou Efthymia Prousali Nikolaos Ziakas

This is a Letter and does not have an abstract. Please download the PDF or view the article in HTML.

IRIS (biosensor)

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10.18502/jovr.v18i1.12735

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Citations (1)

Central Corneal Thickness During Treatment With Travoprost 0.004% in Glaucoma Patients

Journal of Ocular Pharmacology and Therapeutics (2009)

Torsten Schlote Argyrios Tzamalis Myron Kynigopoulos

Experimental studies demonstrated an alteration of corneal collagen structure by prostaglandin analogues. The possible effect of the prostaglandin F(2alpha) analogue travoprost 0.004% on the central corneal thickness (CCT) in newly diagnosed glaucoma patients was evaluated.Consecutive, interventional case series. Seventy-four patients/136 eyes with glaucoma were included in the statistical analysis. All patients received travoprost 0.004% (Travatan(R)) once daily in one or both eyes. CCT was measured by using noncontact optical low-coherence reflectometry prior to the treatment and after 6 and 12 months.Mean CCT of all treated eyes (n = 136) was 546.71 +/- 34.63 mum at baseline, 535.14 +/- 34.78 mum after 6 months, and 532.38 +/- 34.18 mum after 12 months (ANOVA, P < 0.001). Ninety-five percent of all treated eyes showed a decrease of CCT. CCT reduction mainly developed within the first 6 months of the treatment period. After 12 months, a CCT reduction >30 mum occurred in 5.1% of all treated eyes. There was a significant correlation between the magnitude of corneal thinning and the initial CCT but not between corneal thinning and IOP reductions.Topical therapy with the prostaglandin derivate travoprost is accompanied by a significant reduction of CCT within one year of treatment. Further clinical studies are needed to evaluate the possible long-term effects of prostaglandins on the CCT of glaucoma patients.

Travoprost

Prostaglandin analogue

10.1089/jop.2009.0007

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Citations (27)